Myocardial infarction with non-obstructive coronary arteries: etiology, diagnosis, treatment and prognosis

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is responsible for about 10% of all myocardial infarctions. In the past, patients were thought to have good prognosis and, due to paucity of research, evidence-based management and treatment strategies were scarce. Today, researchers and physicians recognize this as a condition with not so trivial mortality and morbidity. Therapy strategies are highly dependent on finding the underlying disease mechanism that led to infarction in each patient. However, to arrive at a MINOCA diagnosis, a multimodal approach is required and, despite an optimal work-up, the cause remains unknown in 8-25% of patients. More recently, research has been growing and position papers from the European Society of Cardiology (ESC) and the American Heart Association (AHA) have been published, and MINOCA has been integrated into the more recent ESC guidelines on myocardial infarction. Nonetheless, some clinicians still suppose that the absence of coronary obstruction rules out the possibility of acute myocardial infarction. Therefore, in the present paper, we aim to compile and present the available data on the etiology, diagnosis, treatment, and prognosis of MINOCA.